The ocular fundus changes and the damage of visual function were various at different stages of diabetic retinopathy (DR). To get hold of timing and different therapic method correctly of early diagnosis, whole body treatment, laser photocoagulation and vitreous-retina surgery and adopting targeted interventions could help patients receiving the most reasonable and effective treatment at different stages, both of them are keys to reduce the damage of visual function. （Chin J Ocul Fundus Dis，2008，24：240-243）
Objective To estimate the prevalence rate and risk factors of diabetic retinopathy (DR) in rural residents in Shandong．Methods A total of 16 330 residents in 8 counties in Shandong province underwent the screening of diabetes by multistage randomized clustersampling; while the standard of diagnosis of diabetes was in accordance with the WHO standard (1990). Diabetes was diagnosed in 707 residents who then underwent questionnaire survey and examinations of fasting bloodglucose，urine protein, visual acuity, slitlamp microscope, and direct opthalmoscope. The standard of DR screening was drawn according to the international DR classification (2002). The data were statistically analyzed with SPSS 11.5 software. Results In 16 330 residents,707 were with diabetes (4.33%), 26.30% of them (181 cases) had DR (1.11% of all the residents). Multivariable analysis showed that kidney damage, hypertension and high blood glucose were the risk factors for DR; while the age, sex, and family history were not related much to DR. Conclusion The prevalence rate of DR in rural residents of Shandong is high. Kidney involvement, hypertension and high blood glucose are the risk factors of DR.
Objective To observe the ocular fundus features and consistency of classification of diabetic retinopathy (DR) by ultra-wide-field fluorescein angiography (UWFA) and the simulated early treatment diabetic retinopathy study (ETDRS) 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Ninety-six eyes of 55 DR patients were included. The ages ranged from 25 to 73 years, with a mean age of (41.34±15.07) years. UWFA examination (British Optos 200Tx imaging system) using the protocol for obtaining 7SF images as described in the ETDRS, 7 circular regions with a range of 30 degrees are spliced as 7SF templates to determine the observation range. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. And the visualized area of the retina, retinal non-perfusion (NP) area, retinal neovascularization (NV) area, and pan-retinal photocoagulation (PRP) area of UWFA and 7SF were quantified by a retinal specialist. Results UWFA imaging and 7SF imaging have a high degree of consistency in judging DR classification (kappa=0.851,P=0.000). The retinal visual area, NP area, NV area and PRP area of the UWFA imaging were 3.16, 3.38, 2.22 and 3.15 times more comparing with the simulated 7SF imaging (t=213.430, 45.013, 22.644, 142.665;P=0.000, 0.000, 0.003, 0.000). The lesions of 8 eyes were found outside the range of simulated 7SF imaging, including peripheral NP in 5 eyes, NV areas in 3 eyes, respectively. Conclusion UWFA imaging and simulated 7SF imaging are consistent to judge DR classification, but UWFA can find more peripheral retinal lesions.
ObjectiveTo observe the preliminary clinical application value of the handheld non-mydriatic visual electrophysiological diagnostic system RETeval in screening for diabetic retinopathy (DR).MethodsRetrospective clinical study. Fifty-eight patients with type 2 diabetes mellitus and 16 normal subjects who were admitted to Wuhan General Hospital of the PLA from November 2017 to May 2018 were enrolled in this study. All patients had not received any ophthalmologic treatment. All patients were examined by the default “DR assessment protocol” model of the RETeval device, and the “DR score” were measured by the system. The FFA results were used as the gold standard, and the DR was graded according to the international DR grading standard established in 2002. Patients were divided into vision threatening DR (VTDR) positive group and VTDR (−) group, DR (+) group and DR (−) group. Two independent sample t tests was used to compare the implicit time, amplitude, and pupil area ratio between eyes of different groups. Spearman correlation analysis was used to analyze the relationship between “DR score” and DR severity. The receiver operating characteristic area under the curve (AUC) assesses the sensitivity and specificity of RETeval in detecting DR and VTDR. The threshold of sensitivity and specificity was determined by using the maximum Youden index as a standard.ResultsThe AUC of DR was 0.936, the sensitivity was 81%, the specificity was 92%; the AUC of VTDR was 0.976, the sensitivity was 96% and the specificity was 70%. Compared with DR (−) group, the implicit time of DR (+) group was delayed and the amplitude and pupil area were decreased (t=－13.43, 5.49, 6.09; P=0.000, 0.000, 0.000). Compared with VTDR (−) group, the implicit time of VTDR (+) group was delayed and the amplitude and pupil area were decreased (t=－11.05, 7.46, 5.73; P=0.000, 0.000, 0.000). The “DR score” was significantly correlated with the severity of DR (r=0.89, P＜0.05).ConclusionsThe “DR score” measured by the RETeval instrument has a high degree of specificity and sensitivity in the diagnosis of DR and VTDR. It is highly correlated with the severity of DR.
ObjectiveTo compare the consistency and difference of nonmydriatic ultrawide field retinal imaging system versus nonmydriatic 2-field 45°digital fundus photography system in a large-scale diabetic retinopathy (DR) screening. MethodsA total of 733 with type 2 diabetic patients (1466 eyes) underwent nonmydriatic ultrawide field retinal imaging and nonmydriatic 2-field 45°digital fundus photography examination. Two independent readers graded images respectively to determine the stage of DR. A third masked retinal specialist adjudicated discrepancies. Using nonmydriatic 2-field 45°digital fundus photography examination as the standard, the consistency of nonmydriatic ultrawide field retinal imaging was evaluated. The statistic index included sensitivity, specificity, Youden index and Kappa value. The difference of two methods was analyzed by comparative t-test. ResultsBased on nonmydriatic ultrawide field retinal imaging, the results were as follows: non DR (NDR) in 1062 eyes (74.1%), DR in 340 eyes (23.7%), ungradable in 32 eyes (2.2%). Among 340 DR eyes, there were mild nonproliferative DR (NPDR) in 48 eyes, moderate NPDR in 216 eyes, severe NPDR in 57 eyes, proliferative DR (PDR) in 19 eyes. Based on nonmydriatic 2-field 45°digital fundus photography, the results were as follows: NDR in 1080 eyes (75.3%), DR in 270 eyes (18.8%), ungradable in 84 eyes (5.6%). Among 270 DR eyes, there were NPDR in 36 eyes, moderate NPDR in 175 eyes, severe NPDR in 53 eyes, PDR in 6 eyes. Compared with nonmydriatic 2-field 45°digital fundus photography for screening DR, the sensitivity was 98.0%, the specificity was 95.0%, and the kappa value was 0.87. For screening severe NPDR and PDR, the sensitivity was 100.0%, the specificity was 99.0%, and the kappa value was 0.94. The DR detection rate and the ratio of the picture can't interpretation between two methods both had significant difference (P=0.00). ConclusionsIn rapid large-scale DR screening, there is high consistency between nonmydriatic ultrawide field retinal imaging versus nonmydriatic 2-field 45°digital fundus photography. Nonmydriatic ultrawide field retinal imaging is proved to be more adaptive, and more comprehensive and precise.
Diabetic retinopathy (DR) is one of the microvascular complications of diabetes mellitus (DM). Like other macrovascular complications of DM, the development and progression of DR is influenced by a variety of systemic and local factors. It is essential to understand the importance of multidisciplinary collaboration. Systemic risk fators such as hyperglycemia, hypertension, dyslipidemia and diabetic nephropathy should be treated before effective DR management can be implemented. Through multidisciplinary collaboration, we can prevent the development of DR, slow the progression of DR, and improve the safety of perioperative care. Thereby enhancing the level of prevention and control of DM complications, including DR.
Purpose To observe the color motion perception of patients with diabetic retinopathy (DR) in very early stage and find a good way to diagnose early DR in time． Methods The motion perceptions of patients with early DR and normal subjects were tested by using equiluminant moving chromatic grating and moving luminance grating generated on VGA monitor in a PC compatible computer and the results were compared with those of electroretinogram(ERG),oscillatory potentials(OPs) and color perception． Results When the two gratings were of equal spatial frequency and equal time frequency,the normal subjects judged that chromatic grating moved faster than luminance grating．Very signifincant differences were detected between blue/yellow grating and black/white grating while the luminance contrast of was 80% and the velocity was 20.2 mm/s or 14.3mm/s(Plt;0.01).The abnormal ratio of color motion perception(69.2%)was higher than that of color vision(43.6%) and ERG OPs(48.9%) when the luminance contrast of black/white grating was 80% and the velocity was 20.2mm/s. Conclusion The test of color motion perception provides new method for diagnosing early DR. (Chin J Ocul Fundus Dis,1998,14:135-138)
Chinese Guideline of Diabetic Retinopathy was developed by the Chinese Ocular Fundus Society and Chinese Ophthalmological Society. It is the first prevention and intervention guideline document of diabetic retinopathy (DR) in China. Clinical pathways and strategies are clearly identified and described in this document for DR screening, referral, intervention, systematic management and patient education. The new DR stage classification combines the first Chinese DR classification since 1985 and the updated international classification of DR. This guideline is based on Chinese health care system, but also reflects the tradition and innovation, and reaches international practice standard. Learning and practice the guideline will promote the prevention and reduce the occurrence and development of DR in China.